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Federal forms, ICRs, and supporting documents

OMB control number

NRC Form 4, Cumulative Occupational Dose History

OMB 3150-0005 · NRC.

OMB 3150-0005

The NRC Form 4 is used to record the summary of an occupational worker’s cumulative occupational radiation dose, including prior occupational exposure and the current year’s occupational radiation exposure. The NRC Form 4 is used by licensees, and inspected by the NRC, to ensure that occupational radiation doses do not exceed the regulatory limits specified in 10 CFR 20.1501.

The latest form for NRC Form 4, Cumulative Occupational Dose History expires 2027-07-31 and is listed under ICR 202311-3150-004.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form NRC Form 4 NRC Form 4, Cumulative Occupational Dose HistoryForm and Instruction
2023 Final Supporting Statement NRC Form 4.docxSupporting Statement A
NRC Form 4, Cumulative Occupational Dose History Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202311-3150-004 Extension without change of a currently approved collection 2023-11-21 Approved without change
202007-3150-005 Extension without change of a currently approved collection 2020-07-28 Approved without change
201706-3150-007 Revision of a currently approved collection 2017-07-21 Approved without change
201403-3150-003 Revision of a currently approved collection 2014-03-27 Approved without change
201403-3150-001 Revision of a currently approved collection 2014-03-18 Withdrawn and continue
201006-3150-005 Revision of a currently approved collection 2010-10-28 Approved without change
200903-3150-001 No material or nonsubstantive change to a currently approved collection 2009-03-04 Approved with change
200711-3150-005 Revision of a currently approved collection 2007-11-28 Approved without change
200708-3150-001 Revision of a currently approved collection 2007-08-15 Approved without change
200612-3150-001 Revision of a currently approved collection 2006-12-05 Preapproved
200408-3150-002 Revision of a currently approved collection 2004-08-13 Approved without change
200107-3150-005 Revision of a currently approved collection 2001-07-30 Approved without change
199807-3150-003 Revision of a currently approved collection 1998-07-15 Approved without change
199804-3150-004 No material or nonsubstantive change to a currently approved collection 1998-04-21 Approved with change
199506-3150-001 Revision of a currently approved collection 1995-06-23 Approved without change
199207-3150-009 Revision of a currently approved collection 1992-07-16 Approved without change
199106-3150-003 Reinstatement with change of a previously approved collection 1991-06-26 Approved without change
198906-3150-002 Revision of a currently approved collection 1989-06-01 Approved without change
198605-3150-002 Reinstatement with change of a previously approved collection 1986-05-07 Approved without change
198512-3150-002 Revision of a currently approved collection 1985-12-12 Approved without change
198509-3150-001 Revision of a currently approved collection 1985-09-16 Withdrawn and continue
198304-3150-001 Revision of a currently approved collection 1983-04-08 Approved without change
198104-3150-005 Revision of a currently approved collection 1981-04-01 Approved without change